Supportive care needs as an independent risk factor for survival in advanced liver cancer: a prospective cohort study

Patients with advanced liver cancer often experience high unmet supportive care needs (SCN). However, longitudinal changes in SCN and their relationship with survival remain insufficiently understood.

This study aimed to identify factors associated with longitudinal SCN and to examine the prognostic value of SCN in patients with advanced liver cancer.

We enrolled 167 patients receiving transarterial chemoembolization (TACE) combined with targeted therapy and immunotherapy. The Hospital Anxiety and Depression Scale (HADS), Karnofsky Performance Status (KPS), Zarit Caregiver Burden Interview (ZBI), and Supportive Care Needs Survey (SCNS) were administered at baseline and at scheduled 6-month follow-up visits. Longitudinal SCNS total and domain scores were analyzed using random-slope linear mixed-effects models. Survival outcomes were evaluated using baseline Cox, time-dependent Cox, and lagged Cox models, with SCNS modeled as both a standardized continuous variable and categorical need groups.

Follow-up time, treatment response, HADS score, KPS score, ZBI score, education level, economic burden, and Child-Pugh grade were significantly associated with longitudinal SCNS total score. Progressive disease (PD) was associated with higher SCNS total score, whereas partial response (PR) was associated with lower SCNS total score. Domain-specific models showed that different SCN domains had distinct but overlapping determinants. In survival analyses, higher SCN was significantly associated with increased mortality. Each 1-SD increase in baseline SCNS total score was associated with higher mortality risk (HR = 1.95, 95% CI: 1.44-2.65). This association remained significant in the response-stratified time-dependent Cox model (HR = 3.17, 95% CI: 2.04-4.92) and in the lagged Cox model using previous-visit SCNS score to predict subsequent mortality (HR = 2.37, 95% CI: 1.64-3.42).

SCN in advanced liver cancer is dynamic and influenced by multidimensional psychosocial and clinical factors. Higher SCNS total score was independently associated with poorer survival across baseline, time-dependent, and lagged survival models, suggesting that SCN may serve as a dynamic prognostic indicator. These findings support integrating repeated SCNS screening into routine clinical follow-up to facilitate early, individualized supportive care interventions.